On August 12, 2011, the U.S. Department of Health and Human Services issued two sets of proposed rules focus on Medicaid and Children’s Health Insurance Program (CHIP) eligibility and enrollment procedures, as well as eligibility for exchanges, insurance affordability programs and Qualified Health Plans.

An estimated 27 million people will gain coverage through Medicaid or private qualified health plans via the new health insurance exchanges once the Affordable Care Act (ACA) is fully implemented in 2014. It is estimated that a significant percentage of those obtaining coverage will have income fluctuations that will change their eligibility status between public and private coverage options offered through the exchanges.

Under the Affordable Care Act (ACA) much of the expanded coverage will be provided through health insurers offering products on the new health insurance exchanges. To ensure robust markets, exchanges must have in place processes for mitigating the financial risk to insurers associated with enrolling individuals with diverse health care needs.